BILL NUMBER: AB 1032	CHAPTERED  09/27/00

	CHAPTER   701
	FILED WITH SECRETARY OF STATE   SEPTEMBER 27, 2000
	APPROVED BY GOVERNOR   SEPTEMBER 25, 2000
	PASSED THE ASSEMBLY   AUGUST 30, 2000
	PASSED THE SENATE   AUGUST 29, 2000
	AMENDED IN SENATE   AUGUST 25, 2000
	AMENDED IN SENATE   AUGUST 7, 2000
	AMENDED IN SENATE   JUNE 22, 2000
	AMENDED IN SENATE   JUNE 24, 1999
	AMENDED IN SENATE   JUNE 9, 1999
	AMENDED IN ASSEMBLY   MAY 3, 1999
	AMENDED IN ASSEMBLY   APRIL 26, 1999

INTRODUCED BY   Assembly Member Thomson
   (Coauthors:  Assembly Members Aroner, Knox, Kuehl, Longville,
Mazzoni, Romero, and Strom-Martin)

                        FEBRUARY 25, 1999

   An act to amend Sections 12698, 12705, and 12725 of the Insurance
Code, relating to health insurance, and making an appropriation
therefor.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 1032, Thomson.  Health coverage:  federally recognized
California Indian tribes.
   Existing law creates the Access for Infants and Mothers Program,
which is administered by the Managed Risk Medical Insurance Board, to
provide coverage for perinatal and infant care to residents of this
state meeting certain income and other eligibility requirements and
paying certain subscriber contributions.  Funding for the program is
provided by the Perinatal Insurance Fund, a continuously appropriated
fund.
   This bill would provide that a member of a federally recognized
California Indian tribe is a resident of this state for these
purposes.  This bill would authorize a federally recognized
California Indian tribal government to make required subscriber
contributions on behalf of a member of the tribe, as specified.
Because this bill would result in an increase in revenues to the fund
and an increase in expenditures from the fund, it would thereby make
an appropriation.
   Existing law creates the California Major Risk Medical Insurance
Program, which is also administered by the board, to provide major
risk health coverage to residents of this state who are unable to
secure adequate private health coverage because of preexisting
medical conditions and who meet other eligibility requirements and
pay certain subscriber contributions.  Funding for the program is
provided by the Major Risk Medical Insurance Fund, a continuously
appropriated fund.
   This bill would provide that a member of a federally recognized
California Indian tribe is a resident of this state for these
purposes.  This bill would authorize a federally recognized
California Indian tribal government to make required subscriber
contributions on behalf of a member of the tribe.  Because this bill
would result in an increase in revenues to the fund and an increase
in expenditures from the fund, it would thereby make an
appropriation.
   This bill would also make various legislative findings and
declarations relative to the potential offer by health plans of
health coverage to tribal members.
   Appropriation:  yes.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:


  SECTION 1.  This act shall be known and may be cited as the
California Indian Health Insurance Purchase Act of 1999.
  SEC. 2.  The Legislature finds and declares all of the following:
   (a) California's Native American tribes lack access to adequate
health care services and to health care coverage.  The rural areas in
which tribes traditionally have resided and the lack of employment
relationships of some tribal members make health care coverage
difficult to obtain for California's federally recognized Indian
tribes and their members.
   (b) At least two licensed health care service plans have agreed to
offer group health care coverage to members of California tribes
under certain conditions, including requirements pertaining to
eligibility, participation, and tribal contributions toward premiums,
and have agreed to file an undertaking with the Department of
Managed Care describing these efforts.  These health plans have also
agreed to make affirmative efforts to market this coverage to tribes
in California.
   (c) It is the intent of the Legislature that these health care
service plans provide information to the Department of Managed Care,
beginning on or before December 31, 2001, on their marketing efforts
to California tribes, the number of tribes that elect to purchase
coverage, the number of tribal members that are covered pursuant to
agreements with these health plans, and the participation of agents
and brokers in this effort.  It is the intent of the Legislature that
these reports continue annually until December 31, 2006.
  SEC. 3.  Section 12698 of the Insurance Code is amended to read:
   12698.  To be eligible to participate in the program, a person
shall meet all of the following requirements:
   (a) Be a resident of the state for at least six continuous months
prior to application.  A person who is a member of a federally
recognized California Indian tribe is a resident of the state for
these purposes.
   (b) (1) Until the first day of the second month following the
effective date of the amendment made to this subdivision in 1994,
have a household income that does not exceed 250 percent of the
official federal poverty level unless the board determines that the
program funds are adequate to serve households above that level.
   (2) Upon the first day of the second month following the effective
date of the amendment made to this subdivision in 1994, have a
household income that is above 200 percent of the official federal
poverty level but does not exceed 250 percent of the official federal
poverty level unless the board determines that the program funds are
adequate to serve households above the 250 percent of the official
federal poverty level.
   (c) Pay an initial subscriber contribution of not more than fifty
dollars ($50), and agree to the payment of the complete subscriber
contribution.  A federally recognized California Indian tribal
government may make the initial and complete subscriber contributions
on behalf of a member of the tribe only if a contribution on behalf
of members of federally recognized California Indian tribes does not
limit or preclude federal financial participation under Title XXI of
the Social Security Act.  If a federally recognized California Indian
tribal government makes a contribution on behalf of a member of the
tribe, the tribal government shall ensure that the subscriber is made
aware of all the health plan options available in the county where
the member resides..
  SEC. 4.  Section 12705 of the Insurance Code is amended to read:
   12705.  For the purposes of this part, the following terms have
the following meanings:
   (a) "Applicant" means an individual who applies for major risk
medical coverage through the program.
   (b) "Board" means the Managed Risk Medical Insurance Board.
   (c) "Fund" means the Major Risk Medical Insurance Fund, from which
the program may authorize expenditures to pay for medically
necessary services which exceed subscribers' contributions, and for
administration of the program.
   (d) "Major risk medical coverage" means the payment for medically
necessary services provided by institutional and professional
providers.
   (e) "Participating health plan" means a private insurer (1)
holding a valid outstanding certificate of authority from the
Insurance Commissioner, a nonprofit hospital service plan qualifying
under Chapter 11A (commencing with Section 11491) of Part 2 of
Division 2, a nonprofit membership corporation lawfully operating
under the Nonprofit Corporation Law (Division 2 (commencing with
Section 5000) of the Corporations Code), or a health care service
plan as defined under subdivision (f) of Section 1345 of the Health
and Safety Code, which is lawfully engaged in providing, arranging,
paying for, or reimbursing the cost of personal health care services
under insurance policies or contracts, medical and hospital service
agreements, or membership contracts, in consideration of premiums or
other periodic charges payable to it, and (2) which contracts with
the program to administer major risk medical coverage to program
subscribers.
   (f) "Plan rates" means the total monthly amount charged by a
participating health plan for a category of risk.
   (g) "Program" means the California Major Risk Medical Insurance
Program.
   (h) "Subscriber" means an individual who is eligible for and
receives major risk medical coverage through the program, and
includes a member of a federally recognized California Indian tribe.

   (i) "Subscriber contribution" means the portion of participating
health plan rates paid by the subscriber, or paid on behalf of the
subscriber by a federally recognized California Indian tribal
government.  If a federally recognized California Indian tribal
government makes a contribution on behalf of a member of the tribe,
the tribal government shall ensure that the subscriber is made aware
of all the health plan options available in the county where the
member resides.
  SEC. 5.  Section 12725 of the Insurance Code is amended to read:
   12725.  Each resident of the state meeting the eligibility
criteria of this section and who is unable to secure adequate private
health coverage is eligible to apply for major risk medical coverage
through the program.  For these purposes, "resident" includes a
member of a federally recognized California Indian tribe.  To be
eligible for enrollment in the program an applicant shall have been
rejected for health care coverage by at least one private health
plan.  An applicant shall be deemed to have been rejected if the only
private health coverage which the applicant could secure would (1)
impose substantial waivers which the program determines would leave a
subscriber without adequate coverage for medically necessary
services, or (2) would afford such limited coverage, as the program
determines would leave the subscriber without adequate coverage for
medically necessary services, or (3) would afford coverage only at an
excessive price, which the board determines is significantly above
standard average individual coverage rates.  Rejection for policies
or certificates of specified disease or policies or certificates of
hospital confinement indemnity, as described in Section 10198.61,
shall not be deemed to be rejection for the purposes of eligibility
for enrollment.  The board may permit dependents of eligible
subscribers to enroll in major risk medical coverage through the
program if the board determines the enrollment can be carried out in
an actuarially and administratively sound manner.
